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General NPI Number Information
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NPI Number | 1891237376
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Entity Type | Individual
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Provider Name | CHAD KOLLER MS,CAP, ICADC
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Gender | Male
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 3848 FAU BOULVARD INNOVATION CENTER 2, SUITE 200
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City | BOCA RATON
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State | FL
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Zip | 33431
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Country | US
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Telephone | 561-251-7263
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Fax |
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Provider Business Mailing Address
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Address Line | 4242 PINE CONE LN
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City | BOYNTON BEACH
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State | FL
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Zip | 33436
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Country | US
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Telephone | 561-251-7263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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